Trajectory of 10-Year Neurocognitive Functioning After Moderate–Severe Traumatic Brain Injury: Early Associations and Clinical Application

Abstract

Objective: This study aimed to explore the 10-year trajectories of neurocognitive domains after moderate–severe traumatic brain injury (TBI), to identify factors related to long-term neurocognitive functioning, and to investigate whether performance remained stable or changed over time. Method: Seventy-nine patients with moderate–severe TBI between the ages of 16 and 55 years were assessed at 3 months, 1, 5, and 10 years postinjury using neuropsychological tests and functional outcomes. Three hierarchical linear models were used to investigate the relationships of domain-specific neurocognitive trajectories (Memory, Executive function, and Reasoning) with injury severity, demographics, functional outcome at 3 months (Glasgow Outcome Scale-Extended) and emotional distress at 1 year (Symptom Checklist 90-Revised). Results: Education, injury severity measures, functional outcome, and emotional distress were significantly associated with both Memory and Executive function. Education and emotional distress were related to Reasoning. The interaction effects between time and these predictors in predicting neurocognitive trajectories were nonsignificant. Among patients with data at 1 and 10 year follow-ups (n = 47), 94–96% exhibited stable scores on Executive function and Reasoning tasks, and 83% demonstrated stable scores on Memory tasks. Significant memory decline was presented in 11% of patients. Conclusions: The findings highlight the differential contribution of variables in their relationships with long-term neurocognitive functioning after moderate–severe TBI. Injury severity was important for Memory outcomes, whereas emotional distress influenced all neurocognitive domains. Reasoning (intellectual) abilities were relatively robust after TBI. While the majority of patients appeared to be cognitively stable beyond the first year, a small subset demonstrated a significant memory decline over time.

Goal Attainment in an Individually Tailored and Home-Based Intervention in the Chronic Phase after Traumatic Brain Injury

“…Families are also affected and may have to adapt to a new life with their injured family member being dependent on their assistance and support [10][11][12][13][14]. It has been increasingly recognized that TBI is a chronic condition with multiple and interacting effects on health and wellbeing [15][16][17][18], as a significant proportion of patients continue to experience life-long difficulties and impaired functional status [8,[19][20][21][22]. A challenge in rehabilitation after TBI is the heterogeneous nature of sequelae.…”

Trajectories of Cognitive and Motor Functional Independence in Hispanic Individuals During the 10 yrs After Traumatic Brain Injury

“…Forslund et al 23 examined 10-year trajectories using the Glasgow Outcome Scale–Extended in moderate to severe TBI survivors and also found a quadratic trajectory in recovery, with a slight decline in functioning toward the 10-yr point, contrary to their stated hypothesis. In contrast, Sigurdardottir et al 24 looked at neurocognitive recovery at 3 mos and at 1, 5, and 10 yrs and found a linear relationship best fit the data. Of note, both of those studies had small sample sizes and were located in Europe, in contrast to the current study focusing on a large cohort of one minority group in the United States.…”

Hyperbaric Oxygen Therapy Improves Cognition in Patients Severe TBI; A Prospective Study

“…What happens after acute care discharge, and inability to predict quality of rehabilitation services are missed. In a 10-year longitudinal study by Sigurdardottir et al, 94-96% stabilized in function after the first year [33]. This leaves a narrow window within which to maximize a patient's potential gains.…”